Year : 1985 | Volume
: 33 | Issue : 4 | Page : 233--237
Clinical evaluation of nonsteroidal antiinflammatory drugs in postoperative inflammation following cataract surgery
MH Shaikh, KJ Sheth
Department of Ophthalmology, Medical College, Baroda, India
M H Shaikh
Department of Ophthalmology, Medical College, Baroda
|How to cite this article:|
Shaikh M H, Sheth K J. Clinical evaluation of nonsteroidal antiinflammatory drugs in postoperative inflammation following cataract surgery.Indian J Ophthalmol 1985;33:233-237
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Shaikh M H, Sheth K J. Clinical evaluation of nonsteroidal antiinflammatory drugs in postoperative inflammation following cataract surgery. Indian J Ophthalmol [serial online] 1985 [cited 2021 Sep 20 ];33:233-237
Available from: https://www.ijo.in/text.asp?1985/33/4/233/30798
As an anti-inflammatory agent, though, steroids are powerful fey the geed, they are also potent for evil. The relative clinical efficacy of various nonsteroidal anti-inflammatory drugs (NSAID) with regard to intraocular inflammation has not been however widely assessed. The present controlled clinical study was therefore carried out to assess the efficacy of orally administered NSAID namely oxyphenbutazone, indomethacin and ibuprofen in post-operative inflammation following cataract surgery and to assess their comparative value as an alternative to time honoured steroid prednisolone.
MATERIAL AND METHODS
After careful check up to exclude any local and systemic disease, the patients having uncomplicated senile cortical cataract were considered for the admission to this study. The patients were randomly assigned to one of the following groups:
The drugs were started a day before operation and continued in 1 hourly schedule for a total period of 6 days. Postoperatively the local dressing was carried out with chloromycetin ointment and homatropine drops 2% daily. No steroids were topically applied till 5th postoperative day.
Uniform surgical technique was maintained by different operators. The patients who underwent uncomplicated intracapsular cataract extraction were considered eligible for the final analysis.
In addition to cases with operative complications, the patients who developed any local or systemic complications postoperatively were further excluded from analysis.
Pain, Photophobia, Lid Swelling, Conjuctival Congestion, Conjuctival Edema, Circumcorneal Congestion, Striate Keratitis and Aqueous Flare were assessed daily. The pigment dispersion was assessed on fifth day.
Based upon the underlying pathophysiologic mechanisms, each parameter was assessed in 0 to 3 severity scale (Grade-0 Nil, Grade-1 Mild Severity, Grade-2 Moderate, Grade 3 severe) and scored accordingly.
Out of 117 patients which entered the study, 100 patients fulfilled criteria. There were 20 patients in each group.
COMPARISON OF DRUG TREATED WITH CONTROL GROUP
By preoperative administration of drugs we could achieve significant beneficial antiinflammatory effects on each of the parameters assessed right on first post-operative day. This holds true for prednisolone as well as NSAID [Table 1]. With continued administration of the drugs resolution of the inflammation occurred at considerably faster rate in comparision to control group. There is more than 80% reduction of average grand total score in drug treated groups while this amounts to just 45% in control group [Table 2].
NSAID V/S PREDNISOLONE
Not even on a single parameter could prednisolone show antinflammatory efficacy superior to any of the NSAIDs studied. NSAID show superior analogesic effect in early postoperative period compared to prednisolone. Superior efficacy of NSAID on various parameters is evident from [Table 1].
Overall evaluation shows that both oxyphenbutazone and ibuprofen are significantly better than prednisolone as regards their early efficacy observed on 1st day as well as total efficacy achieved by the 5th day. [Table 2]. Indomethacin group patients have lower average grand total scorecompared to prednisolone throughout the ovservation period, the difference however is statistically not significant.
COMPARISON AMONG NSAID
Among nonsteroidal drugs, both Ibuprofen and oxyphenbutazone were found to be better than indomethacin as suggested by overall evaluation. [Table 1]. -Ibuprofen group patients have lower average total symptoms and signs score than those receiving oxyphenbutazone, the difference ish owever statistically not significant. The graphical presentation of average total symptom and sign score once again reveals that Ibuprofen is most effective followed by oxyphenbutzone, indomethacin and prednisolone in that order.
As seen from [Table 1], nonsteroidal have exerted antiinflammatory activity of varying intensity on various parameters.
DAYS OF HOSPITALIZATION
The earliest day by which none of the parameters had score exceeding one was recorded. In comparison to control group, drug treated patients could be discharged earlier from hospital.
There were not a single case of filtering bleb resulting from would leakage in any of the groups attributable to better would closure with multiple corneo-scleral stitches.
There were no severe side effects necessitating drug withdrawal. Ibuprofen group was totally free of GIT side effects.
Pretreatment of animal models and human subjects with NSAID have been shown to prevent the disruption of blood aqueous barrier occurringin response to trauma by preventing,, the synthesis and release of prostaglandlins. It should be noted that similar stabilization of blood aqueous barrier with pre-treatment with steroids is not definitely demonstrated.
Whatever be the underlying mechanisms, the fact of immense clinical importance is that the preoperative institution of antiinflammatory therepy is wiser and more logical policy than starting the therepy after the structure of eye have already been damaged following an exposure to deleterious effects of inflammatory mediators which are invariably released in response to an operative trauma.
Overall superiority of nonsteroidal drugs in suppressing inflammation over prednisolone could be related to property of inhibition of PG synthesis by former class of drugs as a group.
Considering the relative safety of Ibuprofen as regards gastrointenstinal, cardiovascular and haematological toxicity, it emerges to be the NSAID of the choice from our study. Agarwal et al (1982) found overall superiority of oxyphenbutazone (600 mg/day) over Ibuprofen (600 mg/day) and also over prednisolone (20 mg/day). In our study we used the oxyphenbutazone in just the half dosage (300 mg/day) and still we could obtain effects better than prednisolone which was used in the dose as high as 30 mg/day. The vital consideration therefore is that by reducing the dose of oxyphenbutazone, we could reduce the chances of toxic effects which, in the case of oxyphenbutazone are directly dose related. The reduction of dose also means better patient compliance. Further, by using Ibuprofen in dosage of 1200 mg/day, we obtained significant anti-inflammatory effects without having invited extra toxicity.
Ocular penetrability of a drug is critical for the clinical effects. Relatively poor efficacy of indomethacin could be explained if it is remembered that the drug penetrates the eye poorly and is transported out of the eye actively.
Variable effects of NSAID on various parameters can be explained if one remembers that the one of the most characteristic feature of PG synthetase system is that while it seems to be quantitatively similar in different tissues it exhibits profound quantitative differences as regards its inhibition by NSAIDS.
With the use of anti-inflammatory therapy, patients could be discharged at an earlier date. This is of special interest in India where several patients are waiting for their turn of cataract extraction, reduction of days of hospitalization, means a lot.
A controlled clinical trial to evaluate efficacy of various antiinflammatory drugs administered orally rvealed the importance of starting therapy preoperatively. Ibuprofen and oxyphebutazone showed markedly superior efficacy in comparison to prednisolone and indomethacin. The use of nonsteroidal drugs is free from serious local and systemic side-effects. Considering higher efficacy and total freedom from side effects Ibuprofen (1200 mg/day) emerges to be the drug of choice.
|1||Hogan, M. J.. 1959, Amer. J. Ophthalmol. 4-47; 155.|
|2||Leopold, I. H., 1974, Symposium on ocular therapy, The C. V. Mosby Company, Saint Louis, P. 96.|
|3||Bhattacharjee, P., Eakins, E. K., 1975, Prostaglandians, 9 ; 197.|
|4||Zimmerman, T. J. Gravenstein, N., 1951, Amer. J. Ophthalmol 34: 945.|
|5||Mathur, S. K., Satsangi, U. K., 1981, Ind. J. Ophthalmol, 29 :96|
|6||Horribon, D.F.. 1974. Prostaglandians, Churchill Livingstone, Edinburg.|
|7||Agrawal, R. L... Lodhan. C. K., 1982, Ind. J. Ophthalmol, 30: 463.|